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Rating: 
Summary: The Bible of Rheumatology - Still true?
Review: Kelley's et. al., Textbook of Rheumatology has been considered the Bible of Rheumatology ever since its 1st edition. The 5th edition still lays claim to that honour. However, the appearance of Klippel and Dieppe's Rheumatology has effectively relegated it to a second place. Kelley's is lucid and far-reaching into areas of Rheumatology, but it is more concise, less illustrative, and harder to digest than Klippel's. Moreover, the tendency to have the same editors and authors write chapters throughout the history of the book has made the book rather stagnant, with few differences between the 4th and 5th edition. The book is rather ethnocentric in concentrating on research done in USA, largely ignoring research (and authors) from other parts of the world, while Klippel's is more cosmopolitan and has more global representation in authorship and content. For example, in the chapter on Rheumatoid Arthritis in Kelley's, it is held that the occurrence of the disease is constant in different areas of the world, while Klippel's points to evidence to the opposite of that statement. Still, Kelley's is a very useful reference textbook for the specialist rheumatologist who knows quite a bit about his subject, less so for the beginning fellow.
Rating: 
Summary: Kelley's Textbook of Rheumatology by Ruddy et al.
Review: This work has a representative sampling of the major rheumatologic disturbances-their etiology, treatment, post-followup, nutritional implications and implications for
conventional medicinal preparations and alternative medicine.
For instance, the rendition on low back pain is excellent.
"During any month, 32-37% of the population will suffer from low
back pain for a period longer than 24 hours." The cause of
low back pain has many factors; namely, smoking, body vibration,
job stress, sedentary jobs, static posture and strenuous movements. Low back pain is the most common cause of disability
in workers under 45 years of age. Higher levels of exercise and
targeted physical therapy protect against low back pain.
Three major types of forces in the lumbar spine can cause
nerve injury leading to pain; namely, stretch, compression and
vibration. "Increased tension increases intrafascicular pressure and decreases cross-sectional area in the nerve. This interferes
with blood flow, causing venule stasis at 8% stretch and total ischemia at 15% stretch." A decrease in cross-sectional area
makes sense in engineering because the increased length and
decreasing elasticity will cause the nerve to be significantly
distorted . As a result of the distortion, the cross-sectional
area will represent an exaggerated multi-dimensional geometry
having a smaller cross-sectional area. The discussion on
spinal stenosis explains the rationale for compression of nerve
roots. There is an excellent workup for low back pain.
Lumbago has a dull and low back pain component. The herniated
disk has an electric-knife-like stabbing pain. Spinal stenosis
has aching and burning in the thighs. Metastases has serious
and unrelenting pain. Ankylosing Spondylitis has insidious
onset of pain, uveitis and sometimes aortic insufficiency.
The epidural abscess has sharp and severe bilateral buttock
and leg pain. There is an excellent section on nutrition and
rheumatic diseases. The late Paleolithic diet consists of
34% protein and 21% fats; whereas, the American diet consists of
12% protein and 42% fats or twice the Paleolithic dietary
content of fats. A number of vitamins benefit patients
with rheumatologic diseases; namely, beta-carotene, Vit E,
Vit C, Vit D, Zinc, Selenium, Cu and Fe to compensate for
iron deficiency anemia. Linoleic acids, Omega 3 and Omega 6
fatty acids have been found to be essential in the diet.
For the arthritic diseases, "Vegetarian diets, when supplemented with sufficient proteins, vitamins and minerals , can result in a
modest improvement in pain and stiffness."
There is an excellent section on acupuncture. The authors state:
"Because the most obvious application of acupuncture to patients
with arthritis or fibromyalgia is to relieve pain, there has been significant research over the past 20 years on the mechanisms in Western terms that might explain the relief of
pain by acupuncture needles. With the discovery of natural
human opiates, many different studies have shown that reduction
in pain may result from release of endogenous endorphins by
acupuncture needling." In addition, magnetic therapy and
massage therapies have provided relief. The concept that
electrical or magnetic fields modify the perception of pain
fits the gate theory of pain perception. In addition, the introduction of a magnetic field produces a constant molecular disturbance
which may inhibit fusion and; thereby, provide relief. Patients
utilizing magnets must make certain that they are utilizing the
proper NORTHERN polarity and gaussian thresholds to ensure
maximum benefit. The author has an
excellent section which describes the benefits of exercise
for rheumatologic patients. Three types of exercises benefit the
patient; namely range of motion, strengthening/resistive and
aerobic/endurance exercises.In the rehabilitative section,
multi-dimensional gait postures are described. For instance,
there is normal gait, four-point gait, three-point gait and
swing to gait or alternatively swing through gait.
The authors have a good section on statistical sampling to
include Type I and II errors, sample size, bias and confounding,
randomization, blinding (unawareness of treatment), outcomes,
study coordinators, subject recruitment, data analyses,
new drug evaluative processes, biologic treatments, clinical
trials and ethic considerations. There is an exhaustive section
on nonsteroidal anti-inflammatory drugs. These drugs consist of
inhibition of arachidonic acid metabolites and Cox 1/Cox 2
inhibitors. Nonsteroidal anti-inflammatory drugs may have
gastro-intestinal effects, hepatic effects and renal effects for
some patients. The work has many important sections; namely,
o the biology of normal joints
o immune response
o patient evaluation
o musculoskeletal pain and evaluation
o diagnostic imaging
o clinical pharmacology
o rheumatoid arthritis
o spondylarthropathies
o vasculitic syndromes
o structure, function and disease of muscles
o crystal associated synovitis
o arthritis related to infection (bacterial arthritis, lymes,
viral arthritis and acute rheumatic fever
o reconstructive surgery for the hand/wrist, elbow, shoulder,
cervical spine, knee, ankle/foot etc. This work is an excellent addition to any library on conventional
and alternative medicine, current medical technology and popular
protocols both here and abroad.
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